BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 600 East Main Street, Stockton, CA 95202-3029 Telephone: (209) 468-3420 Fax: (209) 468-3433 Web: www.sjgov.org/ehd ABOVEGROUND PETROLEUM STORAGE PROGRAM SURVEY FORM Facility Name: 76 H At : ! Lsky ,- M S Page _L of I Facility Address: 2J ALIvv�'' VfZ City: LiIVDl%� Inspection Date: r o FA #: PR M Program Eleme t: Tank/Container Information Complete for all sites with cumulative aboveground storage of petroleum 21,320 gallons in tanks` and containers`*. Complete one box for each tank or each cumulative container product type. 19 ank (2820) El Containers (2821) #of Containers: TA#r 1 Total Capacity: b gallons Product Type: / (per tank or cumulative for containers by product type) Install Date: ElTank (2820) O Containers (2821 #of Containers: TA#: q 3 2 Total Capacity: _� gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Tank (2820) ❑ Containers (2821) #of Containers: TA#: 3 �� Product Type: Total Capacity: gallons (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 4 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: ❑ Tank (2820) ❑ Containers (2821) #of Containers: TA#: 5 Total Capacity: gallons Product Type: (per tank or cumulative for containers by product type) Install Date: Total Capacity this Page: % 44 , j O gallons Total Capacity for Site: gallons Comments: 7:5 014 Al^ / iazzxio EHD Inspector: Reviewed Date: Entered Date: By Initial:kAA { 0 , 1ct,0 By initial: p 'zA *Aboveground storage tank means a tank that has the capacity to store 55 gallons or mor6 of petroleum.` t / **Container means a storage device designed to be moved when full. EHD 28-01 AST SURVEY FORM 09/12/08